Latest news with #IUD
Vox
13-07-2025
- Health
- Vox
Why doctors are finally taking IUD pain seriously
IUDs are becoming more popular. Now, can we make them less painful? Getty Images IUDs have been a promising breakthrough in birth control, offering both convenience and effectiveness, and their use has exploded over the past few decades. But that progress has often come with some (painful) trade-offs. Vox senior reporter Allie Volpe has been digging into why medicine has been slow to catch up to the pain that IUD insertions can cause and doctors' plans to make the process for more palatable for patients in the future. It is a big reproductive rights story, at a time when those rights are increasingly under threat. I sat down and chatted with Allie about it. Allie, are IUDs becoming more popular? What do people like about them? They're definitely more popular. Just over 6 million people, or 8.4 percent of contraceptive users between the ages of 15 and 49, use IUDs. It's actually the fourth most popular form of birth control. No. 1 is tubal ligation or, as people refer to it, getting your tubes tied. The pill is No. 2, condoms are No. 3, and IUDs are No. 4. That's a huge increase from the mid-'90s when just 1 percent of birth control users used IUDs. Today, Explained Understand the world with a daily explainer, plus the most compelling stories of the day. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. People really like the IUD. It's a set-it-and-forget-it kind of thing. Once you get past the act of placing it, you have it for anywhere from three to 10 years, depending on the type you have. Both do the same thing: They prevent the sperm and egg from meeting. A lot of people report less cramping on their periods, lighter periods, or even no periods in general. That's a huge draw for people who often have painful periods or endometriosis. It's a good way to treat those things. I think a lot of people have the perception of IUDs as a quick, painless insertion that's not really a big deal. Is that accurate? It depends on who you talk to, right? It is quick. It is all over within a matter of minutes unless you're getting anesthesia, which would make the process longer. And for some people, it's historically not been all that uncomfortable. But for others, it's really uncomfortable. Pain is very personal, and it's hard to pinpoint what pain actually is. Some people are like, 'Yup, didn't really feel it.' Others are like, 'I've had multiple children, and this is more painful than childbirth.' What we've been seeing over the last couple of years is those people coming on social media talking about their experiences with painful IUD insertions. Why do you think that misconception persists? Why do even doctors misunderstand the pain that their patients are going through? Women's pain in medicine has long been minimized. There's been reporting over the last couple of years about medical gaslighting, not just in gynecological procedures but across the board. Women will come in with a problem. And for decades, centuries, they've just been written off as being hysterical. Specifically, when it comes to IUDs, as more people got them, you started to hear more stories about these being very painful. It's a numbers game — more people get them, more people are going to have problems — but also a medical history game. You're writing about this now because things do seem to be changing. What's going on? One of the OB-GYNs I talked to said, 'I've been placing IUDs for like 37 years. It's not like I didn't mention that it would be painful, but I just tried not to bring it up. Because if a patient expects something's going to be painful, it's going to be more painful than they really thought.' These conversations about pain were not really happening until recently. Within the last year, the CDC and the American College of Obstetricians and Gynecologists both released recommendations telling doctors to talk to their patients about pain management during IUD placement. Related Why gynecologists think IUDs are the best contraceptive For a while, there just wasn't really good research that pointed to methods that might help during this procedure because the pain can come at multiple points. But these groups are urging doctors to talk to their patients about not only taking ibuprofen to manage the pain after the procedure but also using topical creams or an anesthetic shot during the procedure to reduce discomfort. What questions should patients be asking their doctor? All of the OB-GYNs I talked to really stressed this: Talk to your doctor before your appointment. Because if you walk in the day of, there's not really a lot they can do. So, as you're making this appointment, discuss your concerns with your doctor. Tell them if you're concerned about pain or if you have any past history that might make this procedure more difficult for you. Ask, 'What can you offer me?' Ask as many questions as you want. If you don't feel satisfied with the options they have — like if you really want a paracervical block but your doctor doesn't offer it — ask if they have recommendations for another provider that will. Then start to talk through a plan with your provider. What medications will they give you pre-appointment? Some doctors now are giving people Xanax to chill out before the IUD insertion. They will probably often tell you to take ibuprofen beforehand. Ask what they will use during the procedure. Make sure you have that clear plan written out ahead of time.
Health Line
10-07-2025
- Health
- Health Line
How Is an Intrauterine Device (IUD) Removed?
For many people, having an IUD removed is a quick procedure performed in a doctor's office. But if the IUD has attached to your uterine wall, it may require a more involved removal. An IUD is a small, T-shaped device that's inserted into the uterus to prevent pregnancy. It's one of the most effective forms of reversible birth control, with fewer than 1 in 100 people becoming pregnant each year. What is an IUD? There are two types of IUDs: copper and hormonal. In the United States, the copper IUD is known as ParaGard. This T-shaped device contains a stem wrapped with copper wire and two copper sleeves. These parts release copper into the uterus for up to 10 years, preventing sperm from reaching the egg. Hormonal IUDs release progestin into the uterus, thickening cervical mucus to block sperm from reaching and fertilizing an egg. The hormone can also prevent eggs from being released and thin the uterine lining to prevent implantation. There are four different hormonal IUDs. Mirena and Liletta last the longest (up to 8 years). Kyleena works for up to 5 years, and Skyla works for up to 3 years. Removing an IUD A healthcare professional can remove your IUD at any time. You may consider removing it because: You're trying to get pregnant. You've had it for the maximum amount of time recommended, and it needs to be replaced. You're experiencing prolonged discomfort or other undesirable side effects. You no longer need this method of birth control. For most people, the removal of an IUD is a simple procedure performed in a doctor's office. To remove the IUD, your healthcare professional will grasp the threads of the IUD with ring forceps. In most cases, the arms of the IUD will collapse upward, and the device will slide out. If the IUD doesn't come out with a slight pull, your healthcare professional will remove the device using another method. You may need a hysteroscopy to remove the IUD if it has attached to your uterine wall. During this procedure, a doctor or other healthcare professional widens your cervix to insert a hysteroscope. The hysteroscope allows small instruments to enter your uterus. You may require anesthesia for this procedure. It can take between five minutes to an hour to complete a hysteroscopy. Recent research also indicates that an ultrasound-guided removal is an effective way to take out an IUD that won't come out with forceps. This procedure can be less invasive than a hysteroscopy and more cost-effective. Living with an IUD Once you have an IUD placed, you're protected against pregnancy for three to 10 years. The duration that your IUD protects against pregnancy depends on the type of IUD that you choose. You'll have a follow-up appointment about a month after the IUD is inserted. During this appointment, your healthcare professional will make sure the IUD stays in place and hasn't caused an infection. You should also confirm that your IUD remains in place on a monthly basis. After insertion, its strings will hang down into your vaginal canal. You can verify that the IUD is still in place by checking for these strings. You shouldn't be able to touch the IUD. You should contact a healthcare professional if: you have unusual bleeding penetration is painful you can feel other parts of the IUD in your cervix or vagina If you have a copper IUD, you may experience heavier periods accompanied by menstrual cramping. This is usually temporary. Many people find that their cycles regulate two to three months after insertion. If you have a hormonal IUD, you may find that your period is lighter or disappears. Other side effects can include: pelvic pain foul-smelling discharge abdominal pain unexplained fever headaches or migraine IUDs don't protect against sexually transmitted infections (STIs), so it's important to use a barrier method.
Health Line
10-07-2025
- Health
- Health Line
Yes, You Can Use Tampons If You Have an IUD — Here's How
Although tampons and intrauterine devices (IUDs) enter the body in the same way, they don't end up in the same place and shouldn't affect each other. According to Dr. Elle Rayner, an obstetrician, gynecologist, and the founder of The Maternity Collective, people with an IUD can 'absolutely' use tampons. 'Your IUD sits inside the uterus, whereas a tampon is inserted into the vagina, so neither will interfere with each other,' Rayner explains. But it's best to avoid using tampons immediately after your IUD is inserted. 'You're advised to use pads for 48 hours [after],' says Dr. Deborah Lee, a sexual and reproductive healthcare specialist at Dr Fox — Online Doctor and Pharmacy. 'You shouldn't insert anything into the vagina during this time to minimize the risk of infection.' Just how likely is the risk of displacement or expulsion? It's 'very rare' for people to report dislodging an IUD with a tampon, notes Lee. And there isn't much research into it either. What's believed to be the first study in this area found no evidence between tampon use and higher rates of early IUD expulsion. However, more research is needed to fully explore the potential effects of period products on IUD placement. Using a menstrual cup, for example, may increase the risk of expulsion. Of course, other factors can make expulsion more likely, says Lee, including: having heavy, painful periods not having delivered a baby vaginally insertion immediately after a surgical abortion or delivery of a baby the skill of the inserter What exactly causes this? There isn't much evidence — either anecdotal or scientific — to prove that tampons can cause IUDs to move around or fall out. Theoretically, the only way this could happen is if you accidentally catch the strings of the IUD when pulling out your tampon. Your IUD strings shouldn't be long enough for this to be an issue, though. Plus, your tampon strings hang outside your body, meaning you shouldn't have to reach inside to remove it. If your tampon doesn't have a string, take care to only pull at the portion of the tampon closest to the vaginal opening. Is there anything you can do before or after IUD insertion to prepare? Before booking an appointment for IUD insertion, it's a good idea to speak with a healthcare professional about any period-related concerns. For example, your healthcare professional can help you choose the best type of IUD for your body. Hormonal versions tend to make periods lighter or stop them completely, meaning you may not need to use certain period products as much or at all. Doctors can also recommend alternative menstrual products if you have a tilted uterus. Although it's possible to use tampons with a tilted uterus, some people find them difficult to insert. Don't forget to let your IUD inserter know which period products you're likely going to be using, too. 'They may recommend trimming the [IUD] strings a bit shorter to reduce the chance of displacement,' Rayner says. When can you start using a tampon? In the first few weeks after IUD insertion, 'there's a slight increased risk of vaginal infections,' Rayner says. To reduce the risk of infection, some experts advise avoiding tampons for the first month. Depending on the timing of your periods, this may mean you'll need to use different products, like pads, for your first period after getting an IUD. Lee also notes that 'it may be sensible to delay using tampons' until after your IUD follow-up appointment. This is generally recommended 6 weeks after insertion, as 'the highest risk of the IUD being expelled is in the first 6 weeks after fitting,' Lee explains. Is there anything you can do to minimize your risk of complications? Checking that you can still feel your IUD strings after each period will help reassure you that your IUD is still in place. As your cervix can change position throughout your menstrual cycle, it's also a good idea to feel for the strings at different times of the month to determine their location. Of course, if you've had your strings cut short, this may be difficult. Below, Lee explains how to check that the strings are still in place: Wash and dry your hands. Remove your underwear and sit down comfortably on a chair or the edge of a bed. Insert your second and third fingers in your vagina and feel downward and backward, then upward and round the bend, and you should find your cervix. (It's hard and rubbery and said to feel like the tip of your nose.) Feel for the strings. The IUD threads feel like pieces of fishing twine — hard and metallic. Don't worry about whether you can feel one thread or two. As long as you feel them and they seem the usual sort of length, that's all you need to know. Are there any signs to watch for? The easiest way to know if your IUD has fallen out is if you notice it. It could fall into the toilet, for example. 'The worst case scenario is an unnoticed expulsion,' Lee says. 'If you're really unlucky, the first you know about it is a positive pregnancy test.' That's why checking the strings after each period can be important. If the entire IUD has dislodged, you may even be able to feel the coil or plastic stem protruding from the cervix. 'If you're worried you can't feel your strings, or you feel [the IUD] may have become dislodged or fallen out, it's important you get checked to confirm straight away,' Rayner says. 'If you're using an IUD for contraception and you have had unprotected sexual intercourse, you may need emergency contraception,' she adds. 'If it's incorrectly placed or not in situ, you could be at risk of unplanned pregnancy.' You should also use an alternative method of contraception until a healthcare professional has checked your IUD. Try not to panic if the above happens. 'Most often, the threads will be there,' Lee says. 'They may have tucked themselves around the cervix and are lying flush with the surface, so [it may] just not be very easy to feel.' According to Lee, 'If the threads can't be found, [the doctor] will send you for an ultrasound scan to see if the [device] is in the uterine cavity.' But she says, 'If this is the case, the IUD can be left alone until time for removal.' In rare cases, Lee continues, 'Absent coil threads mean the IUD has perforated, meaning the device has passed through the wall of the uterus and into the pelvic cavity. You'll need a laparoscopy — keyhole surgery — to remove it.' Are there any alternatives to consider? If you're uncomfortable with the idea of using tampons, there are plenty of other period products on the market. Some people find menstrual cups and discs more comfortable than traditional tampons. However, one recent study did find a potential link between menstrual cup use and copper IUD expulsion. Therefore, the only completely 'risk-free' products are ones that don't require insertion, such as pads and period underwear. But again, risks with tampons are very, very low.
Vox
10-07-2025
- Health
- Vox
What if IUD insertion didn't have to be so painful?
The appointment before she got her first intrauterine device, or IUD, Ana Ni's doctor asked about her pain tolerance. Low, she said; medium, if she's being generous. The clinic had just begun offering nitrous oxide, or laughing gas, to patients to help manage pain during IUD placements and, given the alternative — to undergo the procedure sans anesthetics — she gladly accepted. Before the insertion late last year, Ni, a 26-year-old health care consultant, took deep breaths of the nitrous oxide. She started to feel woozy. 'Initially you just feel relaxed,' she says, 'and then suddenly you get a bit of a head high, similar to when you would hit a vape. That kind of feeling, but intensify it more.' During the procedure, she continued to breathe the gas through cramping. Without the laughing gas, she suspects the pain would have been more acute. 'I know it's a short procedure,' Ni says, 'but I honestly cannot imagine it without the laughing gas.' Vox Culture Culture reflects society. Get our best explainers on everything from money to entertainment to what everyone is talking about online. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. The reality is more complicated. Many patients felt they were lied to by their doctors whose only option for pain management was over-the-counter painkillers. Studies analyzing social media posts about IUD insertion found that almost all of them mentioned pain and discussed how this pain was minimized. Part warning, part public service announcement, these viral videos not only helped bring to light the real suffering patients were experiencing, but also shaped professional guidance regarding what pain management doctors should offer them. Within the past year, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists (ACOG) released updated recommendations for pain management during IUD placement. Both suggest clinicians offer local anesthetics like lidocaine spray, lidocaine-prilocaine cream, and paracervical block — an injection of anesthetic around the cervix. Other providers are going further, offering anti-anxiety medications or general anesthesia. The most effective way to address pain is perhaps the most straightforward, and the most novel: talking to patients and hearing their concerns. While the ACOG guidance found insufficient evidence to support nitrous oxide use, Ni remembers her doctor telling her how it helped other patients. She had a similarly positive review; she says she'll request it again when she needs to replace her IUD. 'Unless there's some other medication then,' she says. 'But I feel like the laughing gas will suffice.' Over 6 million people in the United States currently use IUDs as contraception, and the evolving pain management standards around them show the medical establishment has moved to address women's pain — and how much more work is left to be done. Aside from having a slate of pain management options on offer, the most effective way to address pain is perhaps the most straightforward, and the most novel: talking to patients and hearing their concerns. The shifting standards around IUD procedures point to the ways doctors are only beginning to see patients as experts of their own bodies, and to take women's concerns seriously. 'This fits right into a movement that has really picked up steam, but I doubt is the norm across medical disciplines,' says Eve Espey, a professor and chair of the department of OB-GYN and family planning at the University of New Mexico. 'But if you approach patient care in that way — in thinking about what a patient might experience with a painful outpatient procedure — [it] would dovetail very nicely into that much more patient-centered approach.' A history of pain in gynecology Intrauterine devices are a form of long-acting birth control that have grown in popularity over the last 30 years, especially among those between the ages of 25 and 34. There are two categories of IUDs: copper and hormonal, both of which prevent sperm from fertilizing eggs. Part of the allure of IUDs is that, unlike the pill, which must be taken daily, an IUD is effective for anywhere from three to 10 years, depending on type. No upkeep, no prescription refills. Some users report less cramping and bleeding during periods and less endometrial pain; others stop getting their periods altogether. 'There's also some literature that says if you tell people that something's going to hurt, that it hurts more, which is true.' Although the insertion itself only takes a few minutes, there are multiple points of pain throughout the procedure. First, the medical professional inserts the speculum, an instrument that opens the vaginal walls, which can be painful for some patients. Then, using a device called the tenaculum, the provider will grasp the cervix to straighten and hold it in place. The depth of the uterus is then measured, which can cause cramping, and finally, the IUD itself is inserted. Espey has placed countless IUDs during her 37-year career as an OB-GYN. For a while, she'd outline the risks and benefits and answer any patient questions. But she wouldn't necessarily emphasize the potential for pain in order to avoid scaring patients. 'We just assumed that if somebody came in for an IUD, that they wanted it,' Espey says. 'It's not that we wouldn't describe the fact that it was painful — I did — but it's also a little tough, because there's also some literature out there that says if you tell people that something's going to hurt, that it hurts more, which is true.' The concern was IUDs would be too difficult and painful to place for anyone else. 'On average,' Epsey says, 'women who have had vaginal births, particularly recent vaginal births, have far less pain with IUD placement than women who have not or who have only had C-sections.' Birth control pills were the go-to contraceptive method for decades, Espey says. But as more evidence emerged about the safety and efficacy of IUDs for people of all ages with uteruses, guidance about who should get an IUD began to change in the 2010s. But even as more people — particularly those who had never given birth — began to get them, the perception that the procedure was only mildly uncomfortable persisted. Indeed, medical providers often rated their patients' pain during IUD placement as significantly lower than what the patients experienced. Women and gender-nonconforming people's experiences in medical settings have long been dismissed. In a 2018 review of scientific literature about gender biases in health care, men were seen as 'stoic' when it came to pain, while women were perceived as being more sensitive to pain and 'hysterical.' Hysteria was a popular medical diagnosis for centuries, almost exclusively used to refer to women. The diagnosis was used to classify women as having a mental disorder associated with sexual and social repression and weak character. Women and gender nonconforming people's experiences in medical settings have long been dismissed. The field of gynecology has similarly nefarious origins. The 'father of modern gynecology,' James Marion Sims, developed gynecological practices by experimenting on enslaved women without anesthesia based on the false stereotype that Black people have higher pain thresholds. Amid the eugenics movement of the 1900s, those with low incomes, people of color, and people with disabilities underwent forced sterilizations. Even as late as the 1990s, contraceptive implants were marketed toward low-income Black communities as a means of controlling reproduction of those deemed unfit or unworthy of parenthood. 'I'm an OB-GYN,' says Ashley Jeanlus, a board-certified OB-GYN in Washington, DC, 'but I'm also not very naive that historically and to modern times, how we take care of patients isn't always patient-centered.' The recent CDC and ACOG pain management guidelines are a welcome change, Jeanlus says. 'We're showing that there is improvement, that we're taking important steps to making sure that we are standardizing care, ensuring that patients are receiving these procedures with compassion and dignity, and we're not telling them to just tough it out anymore,' she says. Better evidence ACOG's pain recommendations, released in May, were almost two years in the making. Between the uproar on social media and a greater availability of research showing the efficacy of local anesthetic during IUD placement and other in-office procedures, clinicians felt it appropriate to make a statement, says Kristin Riley, an OB-GYN and minimally invasive gynecologic surgeon at Penn State Health and one of the co-authors of the ACOG committee opinion on pain management. 'There's a lot more studies about this overall topic,' she says, 'and we wanted to pull it all together in one place where clinicians and potentially patients could see it all together and really give people options.' Both the ACOG and CDC guidelines are just that: recommendations for practitioners. They urge doctors to better understand what pain management options are available and supported by research, and to inform their patients of these options, risks, and benefits. CDC guidelines simply mention topical lidocaine 'might be useful for reducing patient pain.' ACOG goes a step further, saying pain management options 'should be discussed with and offered to all patients seeking in-office gynecologic procedures.' But whether doctors follow the guidelines is completely voluntary. Getting an IUD? Here's how to advocate for yourself. Learn about the different options for pain management. What might be best for you? Discuss your concerns, fears, and preferences with your doctor ahead of time. Don't wait until the day of your appointment to ask about anesthetics or anti-anxiety medication. Ask as many questions as you want until you feel comfortable. Make sure your doctor explains all of your options, which may include referring you to another clinic with more resources. Develop a plan. What medications will you take pre-appointment? What form of anesthetic will your provider use during the procedure? If your doctor isn't taking your concerns seriously or doesn't offer pain management that you want, find a new one. Ask if your doctor has a referral list. Or you could reach out to a hospital affiliated with a university. There might be a higher chance of finding a provider that offers additional pain management there, Jeanlus notes. You can also try searching for a provider who is fellowship trained in complex family planning , which means they have received additional training in abortion and contraceptive care. Pain is complex and subjective, which makes studying it difficult. Patients who have a history of sexual abuse and trauma or prior negative gynecological experiences can also experience greater pain during IUD placement. The number of different pain medicines — injected lidocaine, sprays and gel-based lidocaine anesthetics, over-the-counter painkillers — and the various combinations in which researchers use them in studies make it difficult to reach conclusive results, Riley says. Danielle Tsevat, an OB-GYN at the University of North Carolina at Chapel Hill who studies gynecological pain, says the most conclusive evidence for pain relief during IUD insertion points to a lidocaine paracervical block, especially among patients who have never given birth. During her medical residency a few years ago, Tsevat had a mentor who utilized the anesthetic during IUD placements. She'd seen it used for other procedures, like abortion or miscarriage evacuations, but the shot wasn't commonly used for IUD placements. Other studies have found topical lidocaine gel or creams to be effective at minimizing pain from the tenaculum (the device that holds the cervix in place during the procedure), Tsevat says. Other methods aren't as definitive. Ibuprofen hasn't been shown to help during the insertion, but can ease cramping afterward. Some clinicians will offer anti-anxiety medications since anxiety can put a patient at higher risk for pain, Tsevat says. 'They report improved outcomes after that too,' she says. 'That one also doesn't really have much evidence behind it yet…but it's something that we've seen offered.' Nitrous oxide, what Ana Ni used during her procedure, has also shown promise in studies, Espey says. Meanwhile, misoprostol, one of the pills used in medical abortions, was found by ACOG to cause more abdominal pain during IUD placement. No one option provides a panacea because there is no one source of pain during IUD placement, and the pain itself is relatively short-lived, lasting all but a few seconds. Additionally, a shot itself can be uncomfortable. Perhaps the paracervical block — administered after the speculum is inserted — would be more effective if clinicians waited a few minutes after giving the shot. 'But that also prolongs the procedure too,' Tsevat says. 'A lot of patients just say, 'I want to get this over with and done,' and not be in the speculum for that long.' Related How to get the sexual health care you deserve During her medical training, Fran Haydanek, a board-certified OB-GYN in Rochester, New York, says she was never taught about pain management during IUD placement. After hearing from her patients, and others' horror stories on social media, she began counseling patients on pain management options and offering paracervical blocks in 2021. She estimates 80 percent of her patients opt for the injection, and her practice eats the cost because insurance won't reimburse for the medication, she says. 'There's clear guidelines from medical organizations that are saying this [medication] should be offered,' Haydanek says. 'Doctors should be reimbursed for that.' However, across the board, few providers seem to be offering these medications. In a small recent study, only 28 percent of clinics offered lidocaine, including paracervical blocks, for pain management; 85 percent recommended ibuprofen. Another study that looked at pain medications for IUD placement within the Veterans Affairs Health Care System found that lidocaine was used only 0.2 percent of the time, while nonsteroidal anti-inflammatory drugs were used during 8 percent of IUD placements. Whose pain matters? Perhaps the most effective pain management option is IV sedation or general anesthesia, which ACOG notes requires additional research to determine risks, benefits, cost, and accessibility. It's an even more resource-intensive option. 'I would bet a million dollars that if we studied IV sedation and IUD pain that we would find that it significantly reduces pain,' Espey says. But clinics would need a pharmacy, nursing staff, advanced monitoring equipment, a recovery room — all of which could drive up costs for patients. The many years that passed before women's pain was taken seriously for IUD insertions, as well as the continued lack of research into the cost and accessibility of general anaesthesia, lead to a logical question: Whose pain does the medical establishment take seriously? Men have long been offered pain medication for below the belt treatments. Aside from medications, innovations to the devices used during IUD placement could make the procedure more comfortable. The tenaculum, for instance, the tool that grasps the cervix and is a major source of pain, dates back to the 1800s. A Swiss company, Aspivix, has developed an alternative tool, called Carevix, that uses suction to secure the cervix. The device is FDA-cleared in the US and is used in 21 health care centers worldwide, including at the Indiana University School of Medicine and Columbia University, according to the company's chief marketing officer, Ikram Guerd. Given the absence of a silver-bullet solution, the most consequential change when it comes to addressing pain is far more understated. 'The most important thing that we've done, ironically, is stressed how important it is to talk to your patient,' Espey says. Trauma-informed care — in which doctors take a patient's past into account — puts the patient at the center of treatment. When patients feel safe to discuss prior challenging IUD placements or past sexual assault, the provider can better individualize pain control. Giving survivors of sexual assault control over their medical appointments can help avoid retraumatizing them. But how much control, how much information, is appropriate to share with patients? Doctors walk the fine line between disclosing how much discomfort to expect from a procedure (and potentially causing increased anxiety) and downplaying their concerns. Research shows that the more people expect pain, the more painful the experience actually is. But to say IUD insertion is entirely pain-free might come across as gaslighting. 'Do you minimize pain to reduce that anticipatory anxiety at the expense of potentially looking like you're lying to your patient about something quite painful?' Espey says. For Espey, the sweet spot is offering patients plenty of options, from prescribing anti-anxiety medications prior to the procedure or rescheduling them at a clinic with more resources. 'Just giving patients options really helps people feel like they can make a decision,' she says. In a current study, Tsevat, the UNC OB-GYN, is surveying patients post-IUD placement. The feedback has been interesting, she says. Some patients report low pain, while others have compared the experience to razor blades in their uterus. Some were offered pain management, others were not. One participant, who was getting her IUD replaced after eight years, was delighted when her doctor explained the pain management options available. 'She said it was still painful,' Tsevat says, 'but she was just happy that she had gotten something and [it] helped her experience a little bit.' Most notably, patients hardly ever discussed their experience with their doctors afterward; it wasn't something they thought was appropriate to mention. When patients don't feel seen or taken seriously, it can have lasting impacts and may result in their avoiding future health care. While one aspect of women's pain in medicine is finally being discussed, others with painful periods or endometriosis may still feel dismissed. There's still room for more conversations, more transparency.
RNZ News
09-07-2025
- Health
- RNZ News
Pharmac makes asthma inhalers, IUDs more accessible
Photo: 123RF Pharmac is making it easier for people to access asthma inhalers and IUD contraception - a move the minister says is sensible and costs no one. From 1 August, people using some strengths of budesonide with eformoterol inhalers for asthma will be available for a three-month prescription instead of just one. Mirena and Jaydess Intra-Uterine Devices (IUDs) - which can prevent pregnancy, including by administering hormones - will be able to be stored at doctors' surgeries. This means patients will not need to pick them up from a pharmacy before getting them implanted. Associate Health Minister David Seymour . Photo: RNZ / Mark Papalii Some inhalers will also be able to be kept in doctor's and nurses clinics for emergency use, teaching, and demonstrations. Associate Health Minister David Seymour welcomed the moves, saying it was a result of his instruction for Pharmac to start listening to what patients want. "It's been working," he told RNZ. "They've been consulting on a whole lot of things out of my direction to start listening to patients. "Our philosophy is if we can make life easier at no cost, why wouldn't we do it? Easier access to IUDs, better access to asthma inhalers, two obvious win-wins that we can make and really pleased to see this new culture at Pharmac." Seymour said the changes would mean less visits to the pharmacy for resupply, better asthma management, and an extra option for supply in emergencies. "Doctors and nurses will also be able to keep Mirena and Jaydess IUDs in their clinic and will be able to place them in the same appointment. Pharmac will fund these on a PSO to enable this," he said. "Current settings mean women need to get a prescription from their doctor or nurse, pick their IUD up from a pharmacy, and then bring it back to the clinic to be placed. Pharmac estimates over 21,000 women to benefit from these changes in just the first year of funding. "People told Pharmac that these changes will make a real difference. They will make it easier for people with asthma to get the inhalers they need and improve access to long-acting contraceptives like Mirena and Jaydess. They make sense for people." Pharmac's acting director of pharmaceuticals Adrienne Martin said the changes would help over 140,000 New Zealanders in the first year alone. "People have told us that it will remove barriers, reduce delays, and allow for timelier and efficient care." Asthma and Foundation chief executive Letitia Harding said the decision would make a huge difference for Kiwis living with asthma. "When someone is having an asthma attack, they need treatment immediately - there's no time to get a prescription filled," she said. "Patients often need to keep their reliever inhaler in multiple places - at home, school, work, their car - so enhancing access to life-saving asthma medicine will undoubtedly reduce the morbidity of asthma in New Zealand." The change would make asthma management significantly easier, particularly for families facing transport barriers or juggling multiple repeat prescriptions, she said. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
